Basic Information
| Provider Information | |||||||||
| NPI: | 1619176427 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SHELBYVILLE CLINIC CORP | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SHELBYVILLE INTERNAL MEDICINE ASSOCIATES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 330 FRANKLIN RD 135A-590 | ||||||||
| Address2: | |||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370273280 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8778481463 | ||||||||
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| Practice Location | |||||||||
| Address1: | 841 UNION ST | ||||||||
| Address2: | SUITE C | ||||||||
| City: | SHELBYVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371602611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9316855554 | ||||||||
| FaxNumber: | 9316855555 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2007 | ||||||||
| LastUpdateDate: | 04/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | BREWER | ||||||||
| AuthorizedOfficialFirstName: | DEBBIE | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8778929813 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.